内镜下荷包缝合术用于胃壁切除术穿孔后创面的闭合  

Endoscopic purse-string suture for the gastric wall defect after full-thickness resection

作　　者：张银[1,2] 范志宁[2] 吴洁[3] 黄晓丹[3] 缪林[3] 王翔[1] 

机构地区：[1]江苏省人民医院消化内镜中心,南京210029 [2]江苏省常州市第一人民医院消化内科 [3]南京医科大学第二附属医院消化医学中心

出　　处：《中华胃肠外科杂志》2015年第2期150-154,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81172266）;江苏省医学创新团队与领军人才基金项目（13201127）;江苏省科技创新与成果转化专项资金项目（BL2012031）

摘　　要：目的：探讨利用金属钛夹和尼龙绳进行内镜下荷包缝合（EPSS）闭合胃壁切除术穿孔后创面缺损的临床疗效。方法回顾性分析2013年1月至2014年5月期间江苏省人民医院和南京医科大学第二附属医院通过EPSS治疗的25例胃肿瘤（1例腺癌，24例胃肠间质瘤）患者的临床资料，其中8例为内镜黏膜下剥离术（ESD）穿孔行EPSS修补者，17例为内镜下全层切除术（即主动穿孔）后行EPSS修补者。结果全组患者均顺利完成EPSS修补，手术时间为35．0～75．0（49．8±10．1） min，无术中及术后严重并发症的发生。肿瘤切缘均阴性。术后拔除胃肠减压管的时间为1～3（1．3±0．8） d，术后住院时间为2～10（4．8±2．1） d，住院总费用为1．0～3．1（1．9±0．5）万元。术后1月随访，所有患者均无不适症状，胃镜复查见创面均愈合良好。结论应用传统尼龙绳和金属钛夹进行EPSS能够安全有效地缝合术后创面及穿孔。Objective To evaluate the efficacy of endoscopic purse-string suture （EPSS） with metallic clips and endoloop for the gastric wall defect after postoperative perforation. Methods Clinical data of 25 patients with gastric tumors（1 of gastric adenocarcinoma, 24 of gastric gastrointestinal stromal tumor, GIST） undergoing EPSS in Jiangsu Province People′s Hospital and The Second Affiliated Hospital of Nanjing Medical University from January 2013 to May 2014 were retrospectively analyzed. During the procedure, EPSS was performed in 8 cases with perforation after endoscopic submucosal dissection （ESD）, and in 17 cases with active perforation after endoscopic full-thickness resection. Results Twenty-five patients underwent EPSS successfully. The procedure time was 35.0-75.0 （49.8± 10.1） min. No severe operational and postoperative complications occurred. Tumor resection margin were all negative. Time to withdraw gastrointestinal decompression drainage tube was 1-3 （1.3 ±0.8） d. Postoperative hospital stay was 2-10（4.8±2.1） d and total cost was 10-31（19±0.5） thousand Yuan. One month after the procedure, all the patients received follow-up with no complaint of discomfort, and endoscopy confirmed that all the lesions healed. Conclusion EPSS with metallic clips and endoloop is effective and safe to close the gastric wall defect after full-thickness resection.

关 键 词：胃肿瘤 内镜黏膜下剥离术 内镜下全层切除术 内镜下荷包缝合 金属钛夹 尼龙绳 

分 类 号：R735.2[医药卫生—肿瘤]